Gliederung

Objective

Spinal cord astrocytromas are among the most challenging tumours in neurosurgery. This paper will present surgical techniques and postoperative results for this group of gliomas.

Methods

Hospital files, neuroradiological examinations, intraoperative documentation and follow-up examinations were analyzed. The clinical course was documented with a neurological scoring system for each symptom and the Karnofsky score. Recurrence and survival rates were determined according to Kaplan-Meier statistics.

Results

Among a series of 186 patients with intramedullary tumors treated between 1977 and 2003, 62 patients (33%) harboured astrocytomas. They presented at an average age of 29Â±18 years. 59 patients underwent a total of 65 operations after an average history of 32Â±44 months. Mean follow-up was 38Â±41 months. The majority were removed subtotally or partially (63%), while 17% were resected completely and the remaining 20% decompressed and biopsied. 22% were classified as malignant, i.e. grade III or IV. All malignant tumours were removed partially. Complications were observed in 17% with wound infections and CSF leaks being the most common. In most patients, no significant postoperative improvement was observed with an unchanged average Karnofsky score in the first postoperative year (64Â±19 preoperatively vs. 65Â±19 after 1 year). Recurrence rates were related to the extent of tumour resection and histological grade. No recurrences occurred after complete resections within 10 years. After partial resection, recurrence rates of 23%, 35% and 51% were determined after 1, 5, and 10 years, respectively. After biopsy and decompression, all patients experienced a recurrence within 1 year. For benign astrocytomas, the recurrence rates were 26% and 30% and for malignant astrocytomas 56% and 87% after 1 and 5 years, respectively. Likewise, survival was related to histological grade: 86% and 71% of patients with benign tumours and 49% and 24% with malignant tumours survived for 1 and 5 years, respectively.

Conclusions

Spinal cord astrocytomas show a variable clinical course depending on histological grade. In this series, an increasing number of benign astrocytomas could be removed completely with increasing experience and improved preoperative imaging. However, even after incomplete resections these tumours show a benign postoperative course in the majority of patients. Malignant astrocytomas still carry a grave prognosis regardless of treatment.